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PERMITTEE NAME/ADDRESS (Include Facility Name/Location ifD~erent) <br />NAME ~ { i S';',jr ~ %) ~ I . ~~.:.. ~.` .:P'}; fi :'Y' ~--}---~- <br />ADDRESS L(.a. }~:.}`,t~.~` :?. ~~I~ { f~}~I'? i.}f~! }^s . tu,r;. <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />,~ ~t=c ;.} n.. ~. , . <br />PERMIT NUMBER DISCHARGE NUMBER <br /> <br />FACILITY } <br />r <br />` <br />? <br />: <br />~'=C <br />~ <br />! <br />' ~~ `-t ' """ ' f`-" MONITORING PERIOD <br />,. <br />1 <br />~ <br />t <br />.; <br />LOCATION r- <br />i <br />lT <br />' ,.. <br />' <br />,,~; <br />. <br />'?.:~:. <br />YEAR <br />MO <br />DAY <br />YEAR <br />MO <br />DAY <br />~ <br />} <br />~ rCj <br />.., <br />_. Cf 1-i ~ ~ ... FRO <br /> <br />M ~ ?r- ~. <br /> <br />~. O <br /> <br />T <br /> <br />. ~ <br />~. <br /> <br />, ~. <br />Form Approved. <br />r°t 7. I`+Ik;}Pt OMB No. 2040-0004 <br />j-` ,~ a.i~: ( -: ;....it l..r`~~:_.. ~1~ i..r il'"1~t~1 <br />ii . , , <br /> <br /> c< ••~-. ~....-.~.~ .~.~.~ .w vow ~c wn ~N~euny uu s wnn. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREQUENCY <br />OF SAMPLE <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS TYPE <br />?~! 13__ r1}°;~ iw . t ?;; : ` <br />- <br />t~ I ~l~€~f.._ SAMPLE <br /> <br />MEASUREMENT ~ ~,..-:1. .;~.~. <br />(, ~7d. J <br />it ;l..~..;; aI. <br />: -:+• : ~. ; •~~ . <br />•.i #- ,; ~..I..~. <br />k4f't <br />_ ' " <br />" ' <br />" <br />~ ,. <br />)w.F'I^'L.ZJ~W}`~( t' !~'Ik:?`-; ~ V+4i...t.P PERMIT <br />REQUIREMENT #•~-# <br />.~•iF# ~~1=*CJI±' <br />I <br />~T~la`t" I"{~X .~-r= :'. <br />I* <br />i••a~= ~~ iE##-3~## 3t##3t~'~~t ~••3t#'IF## : a~.i;.~ <br />.x ;. .;, ;; ,f;~~~~_`l J I:..,f~A <br /> SAMPLE <br />MEASUREMENT <br /> <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br />MEASUREMENT <br /> <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br />MEASUREMENT <br /> <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br />MEASUREMENT <br /> <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br />MEASUREMENT <br /> <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br />MEASUREMENT <br /> <br /> PERMIT <br />REQUIREMENT <br />NAME~TITLE PRINCIPAL EXECUTI E OFFICER I certify under penalty of law that this document and au attachments were T ELEPH <br />N <br /> <br />~ ? p ^ ~ <br />` <br />prepared under my direction or supervision in accordance with a system designed <br />/ O E DA TE <br />~~~ ~ ~ <br />!I' `/ <br />to assure that qualified personnel properly gather and evaluate [he information <br />submitted. Based on my inquiry of the person or persons who manage the system, <br />or those persons directly responsible for gathering the information, the information ~~ <br />G_(//`J/ <br /> <br />~ <br /> <br />/ <br /> submitted is, to the best of my knowledge and belief, true, accurate, and complete. SIGNATURE OF PRINCIPAL EXECUTIVE 9 <br />~/ ~~ ~~ j <br />"" ~~ ~ <br /> <br /> <br />ED OR PRINTED <br />I am aware that there are significant penalties for submitting false information, / / <br />TYP <br />COMMENTS OND EXPLANATION OF ANY VIAL including the possibility of fine and imprisonment for knowing violations. <br />ATIANC /Roforonrn ~u ~w~..-....es~ r......r OFFICER OR AUTHORIZED AGENT CODE NUMBER YEAR MO DAY <br />~ ~ ~ `d I. :K li.. =' !~~' 9f~:V ~':14)::_~ ~ r. ~ S } 1 J -4 ~. (..~t_.. A:i '-'r~".. 4'1A I idt SY.~.~ ;~' _: L'. F..~I._~~17~~ ~~i... w ~.J ;.3 ~ ~ .. i"V ~')1- .... _~ ~~ LZ~ ,.- <br /> t ~l F ~ tttti _ <br />y ~-- __ { <br />c' <br />l~~~z t~ <br />_ .. . r... . _. ... <br />.. ~. ., ~ - <br />ES13-ha"!: !'.3<-,~ IF~DI11 °~'c :~A?_-?"C_E~;;r~t_-- -s.,~~,tl.:`° t.t'-;_ ._.?._ 4=J<<,? ~t=~. F"ili~. t,~}'r`1~ ~<rt';. I ~ [_.....~a ~.a~p_.3! ~ Li~.. .,- -_ ~_l,';..~._f~} C) ~ <br /> .~_~~.~ <br />~ 't -x r i:.. I 1:: <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. PAGE <br />Kj <br />